OPERS Health Care 2021 Open Enrollment Guide For optional vision and dental coverage
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OPERS Health Care
2021 Open Enrollment Guide
For optional vision and dental coverage
Your vision and dental
plan details are inside.
Look for changes
that may apply to you.
Watch out for scams. You may receive calls
and mail from other insurance agents and
brokers offering medical and prescription
drug plans. To remain eligible to receive your
monthly HRA deposit, you must be enrolled
in a medical plan through Via Benefits.
OPERS Plan Coverage – What you need to know in 2021 Via Benefits Reminders
• The Health Reimbursement
OPERS will continue to offer optional vision and dental plan coverage in
Arrangement (HRA) base allowance
2021 to all retirees and eligible dependents.
amount remains at $450. Your
monthly HRA deposit will remain the
2021 Cost and Coverage Highlights
same as it was in 2020.
Vision plan, administered by Aetna
Both High and Low plan options will see a minimal monthly premium • Call Via Benefits between Oct. 15 and
decrease. Coverage under both the High and Low plan options will be Dec. 7 to review plan options.
unchanged for 2021.
• Submitting for reimbursement:
Dental plan, administered by MetLife NEW! In 2021, premiums for the
Both High and Low plan options will see a minimal monthly premium OPERS vision and dental plans will be
decrease. Coverage under both the High and Low plan options will be automatically reimbursed monthly
unchanged for 2021. from your HRA account with no
additional forms to complete or
Action Required receipts to provide. If you do not wish
to have these premiums automatically
• Review 2021 vision and dental plan details within this guide. If
reimbursed monthly from your HRA
you are dually enrolled in a vision and/or dental plan with OPERS and
account, you can opt out by using the
Via Benefits, take some time to review your coverage and needs to
enclosed form.
determine if both plans are needed.
• Enrolling, making changes or canceling vision or dental coverage? Recurring premium claim forms
Fill out the enclosed form or call OPERS between Oct. 15 and Dec. 7, for Medicare Part B premiums (if
2020. Contact Via Benefits to make changes to vision or dental plans applicable) must be resubmitted each
offered through Via Benefits. year.
• No changes? No problem. Your current plan will automatically If previously set up (and plan
continue in 2021. selections do not change), automatic
reimbursement will continue.
Changing medical plan carriers?
If so, automatic reimbursement
arrangements for your old plan will not
carry over to your new plan. Reach out
to Via Benefits for assistance.
2021 Open Enrollment Guide - A 1
2
Eligibility and Enrollment
Anyone receiving a pension benefit qualifies for OPERS When Can I Enroll in the Vision and/or Dental Plan?
vision and dental coverage, even if you don’t qualify for You may enroll only when you first retire or during the
medical or prescription drug coverage. You may also enroll: annual open enrollment period. After you enroll, you and
your family members must stay enrolled until the next
• A spouse — must have a valid marriage certificate. open enrollment period unless you have a change in family
• Child(ren) — must be a participant’s biological or status, including a divorce, death or a child reaches age 26.
legally adopted child or minor grandchild if the You must notify OPERS immediately if you have a change in
grandchild is born to an unmarried, unemancipated family status.
minor child and you are ordered by the court to
provide coverage pursuant to Ohio Revised Code When Can I Enroll New Family Members?
Section 3109.19. The child must be under the age of You may enroll newly eligible family members within 60
26 regardless of enrollment as a full-time student or days of the date they become eligible (such as the date
marital status. Coverage may be extended beyond of marriage or birth). You must contact OPERS for the
the age of 26 if the child is permanently and totally appropriate enrollment form and return this form, complete
disabled prior to age 22. and with the required documentation, within 60 days.
If you are in the OPERS health care plan and receive a How Will Premiums Be Paid?
monthly benefit as the surviving spouse or beneficiary Your premium cost for the plan(s) you select will be
of a deceased retiree or deceased member, you may only deducted from your benefit payment each month. If
enroll those dependents who would have been eligible you are a Medicare participant receiving a monthly HRA
dependents of the deceased retiree or member as defined deposit, your premiums will be automatically reimbursed
on this page. It is your responsibility to notify OPERS, in monthly from your HRA account in 2021. If you wish to opt-
writing, within 30 days of the date your dependent fails to out of this automatic reimbursement, please do so using
meet eligibility requirements. Failure to notify OPERS could the enclosed form.
result in overpaid health care claims or reimbursement for
which you will be responsible to repay.
2021 Open Enrollment Guide - A 3
Aetna Vision Plan
Aetna Vision Preferred, administered by EyeMed, is available • Shop online for contacts or glasses online with
to you and your eligible dependents. If you choose to enroll retailers in Aetna’s network. Your vision benefits will
in the vision plan, you’ll be responsible for paying the entire automatically apply when you check out.
premium for this coverage and you will remain enrolled
for the full year. Once enrolled, changes can only be made Discounts and savings
during the next open enrollment period.
You can find discounts on products and services through
Plan Feature Highlights in-network providers. These discounts include:
• A comprehensive eye exam. Not only can eye exams • 20 percent off any balance over your frame allowance
detect serious vision conditions such as cataracts and • 15 percent off any balance over your conventional
glaucoma, but also the early signs of diabetes, high contact lens allowance
blood pressure and other health conditions. • Up to 40 percent off extra pairs of prescription
• Savings of approximately 40 percent on eye exams eyeglasses and sunglasses
and eyewear. • Up to 20 percent off noncovered items, including
nonprescription sunglasses and lens extras/add-ons
• Your choice of leading optical retailers and private like antireflective coatings
practitioners include, LensCrafters, Target Optical and • Up to 15 percent off the retail price or 5 percent off
Pearle Vision locations. the promotional price for LASIK laser eye surgery or
• Freedom to use any provider. You can also visit any photorefractive keratectomy from U.S. Laser Network
licensed eye care provider outside the network. Keep • Discounts on LASIK surgery through QualSight
in mind that you may pay more out of pocket and may • 40 percent off hearing exams and special pricing on
have to file your own claims. hearing aids
• Digital tools. You can search for providers, manage
your benefits and view your ID card on Aetna’s mobile
app or by visiting aetnavision.com. Search providers
by name, location or even by the brand name of the
frames you want. Website: aetnavision.com
Phone: 1-866-591-1913
4Aetna Vision Plan
2021 Vision
Coverage High Option Low Option
Coverage type In-Network Out-of-Network In-Network Out-of-Network
Retiree Pays Reimbursement Retiree Pays Reimbursement
to retiree to retiree
Comprehensive $0 copay $65 $0 copay $50
eye exam
Contact lens fit &
follow-up
Standard $17 copay $23 $32 copay $8
Premium $62 copay $23 $77 copay $8
Frames $0 copay up to $140 $78 $0 copay up to $50 retail $44
retail value, 80% of value, 80% of balance
balance over $140 over $50
Lenses
Single Vision $0 copay $45 $5 copay $35
Bifocals $0 copay $60 $5 copay $55
Trifocals $0 copay $80 $5 copay $75
Most premium
$85 - $110 copay $60 $90 - $115 copay $55
progressives
Contact lenses $0 copay up to $240 $228 $10 copay up to $200 $180
retail value retail value
Coverage period for Once per calendar Once per calendar Once per calendar Once per calendar
exams year year year year
Coverage period for Once per calendar Once per calendar Once every two calendar Once every two
frames and lenses year year years calendar years
Note: Coverage is available for lenses and frames - OR - contact lenses, but not both.
2021 Open Enrollment Guide - A 5MetLife Dental Plan
Dental coverage administered by MetLife is optional for you Claims Details
and your dependents. If you choose to enroll in a dental Network dentists may submit your claims for you which
plan, you’ll be responsible for paying the entire premium means you have little or no paperwork. You can track your
for this coverage and will be enrolled for the full year. Once claims online and even receive email alerts when a claim
enrolled, changes can only be made during the next open has been processed. If you need a claim form, call MetLife at
enrollment period. 1-888-262-4874. For questions or a list of preferred dentists,
visit metlife.com/mybenefits.
Choosing a dentist within the MetLife network can help
reduce your costs. You can also choose an out-of-network For more detailed coverage information about covered
dentist, but your out-of-pocket costs may be higher. There services and limitations, refer to opers.org or call MetLife.
are more than 410,000 participating Preferred Dentist
Program dentist locations nationwide, including over
96,000 specialist locations.
Plan Options
You have two dental coverage options to choose from:
High or Low. Once enrolled you can view your Certificate
of Coverage for additional details. Please visit the MetLife
website for coverage details. These certificates explain the
dental options available in the High or Low option dental Website: metlife.com/mybenefits
plans. Phone: 1-888-262-4874
1
MetLife’s negotiated or preferred Dentist Program fees refer to the fees that dentists participating in MetLife’s Preferred Dentist Program have
agreed to accept as payment in full, for services rendered by them. MetLife’s negotiated fees are subject to change.
2
Negotiated fees for non-covered services may not apply in all states. Plans in LA, MS, MT and TX vary. Please call MetLife for more details.
6MetLife Dental Plan
2021
Dental Summary High Option Low Option
Coverage type In-Network: Out-of-Network: In-Network: Out-of-Network:
Preferred Dentist Preferred Dentist
Program Program
Diagnostic and 100% of Negotiated 100% of R&C Fee** 100% of Negotiated 80% of R&C Fee**
Preventive Care Fee* Fee*
Type A: Cleanings,
Emergency Care,
Fluoride treatment,
bitewing X-rays, and
Oral examinations
Oral Surgery and 80% of Negotiated 65% of R&C Fee** 60% of Negotiated 50% of R&C Fee**
Minor Restoration Fee* Fee*
Type B: Fillings,
Simple extractions
and Surgical removal
of erupted teeth.
Major Services and 50% of Negotiated 35% of R&C Fee** 25% of Negotiated 25% of R&C Fee**
Restoration Fee* Fee*
Type C:
Prosthodontics,
inlays, onlays,
crowns, dentures,
pontics, implants
and surgical removal
of impacted teeth.
Deductible†:
Individual $0 $50 $50 $50
Family $0 $100 $100 $100
Annual Maximum
Benefit:
Per Person $2,000 $1,250 $2,000 $1,250
Like most group insurance policies, MetLife group policies contain certain exclusions, limitations, exceptions, reductions, waiting periods and terms for
keeping them in force. Please contact MetLife for details about costs and coverage. Dental plan underwritten by Metropolitan Life Insurance Company, New
York, NY 10166.
* Negotiated Fee refers to the fees that participating Preferred Dentist Program dentists have agreed to accept as payment in full, subject to any copayments,
deductibles, cost sharing and plan maximums.
** R&C fee refers to the Reasonable and Customary (R&C) charge, which is based on the lowest of (1) the dentist’s actual charge, (2) the dentist’s usual charge
for the same or similar services, or (3) the charge of most dentists in the same geographic area for the same or similar services as determined by MetLife.
†
Applies to Type B and C Services.
2021 Open Enrollment Guide - A 7General Information
Before making any decisions, please review the 2021 vision and dental
plan details within this guide.
• If you have specific questions about how much the plans pay for certain
services, please call the plan administrators directly.
• If you are enrolled in a vision and/or dental plan with both OPERS and Via
Benefits, take some time to review your coverage and needs to determine if
both plans are needed.
Enrolling, making changes or canceling vision or dental coverage? Fill
out the enclosed form or call OPERS between Oct. 15 and Dec. 7, 2020. If you
choose to discontinue coverage, you may do so over the phone.
Health Care Open Enrollment Change Form: Things to Know
After OPERS receives the forms, they are electronically processed. To ensure your
changes are communicated correctly, please follow these instructions:
1. Complete the form using blue or black ink.
2. Do not attempt to correct your address using this form.
3. Do not use the boxes provided to make coverage selections. Do not hand-
write your selections or make other notes on the form.
4. Because of limited space, all covered dependents may not be pre-printed on
the form. Please refer to page 1 of the statement to see a full list of currently
covered dependents. If you wish to make coverage changes for dependents
not listed on the form, please indicate these changes on a separate sheet of
paper.
5. Use Section 4 on this form to enroll a spouse or child who is not currently
enrolled. Dependents may only be enrolled in programs in which you are
enrolled. Please provide all of the required documentation listed on the form.
No changes? No problem. No action is needed by you. You do not need to
complete the Health Care Open Enrollment Change Form or contact OPERS by
phone as your current plan will automatically continue in 2021.
8OPERS Board of Trustees
The 11-member OPERS Board of Trustees is responsible for the Services for the state of Ohio is a statutory member, and three
administration and management of OPERS. Seven of the 11 members are investment experts appointed by the Governor,
members are elected by the groups that they represent (i.e., the Treasurer of State, and jointly by the Speaker of the Ohio
college and university non-teaching employees, state, county, House of Representatives and the President of the Ohio Senate.
municipal, miscellaneous employees and retired members); the For a current listing of the OPERS Board of Trustees, please visit
Director of the Department of Administrative opers.org.
The plan features within this document are valid only for the 2021 plan year.
This document reflects information as of the date listed herein. There is no promise, guarantee, contract or vested right to access to
health care coverage or a premium allowance. The board has the discretion to review, rescind, modify or change the health care plan
at any time. This document is written in plain language for use by members of the Ohio Public Employees Retirement System. It is not
intended as a substitute for federal or state law, nor will its interpretation prevail should a conflict arise between it and the Ohio Revised
Code, Ohio Administrative Code or Internal Revenue Code. If you have questions about this material, please contact our office or seek
legal advice from your attorney.
Ohio Public 277 East Town Street Web Facebook
Employees Columbus, Ohio opers.org facebook.com/ohiopers
Retirement 43215-4642
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